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DIAGNOSIS
Be sure to discuss your risks for heart disease with your health care professional during regular checkups. If you are experiencing any unusual symptoms, tell your health care professional about them all—when each started, how often it happens, and if it has been getting worse. Also note any stresses in your life, taking care of a sick parent or partner.
Standard cardiac screening is not as accurate at diagnosing women's heart conditions as it has been for evaluating men's symptoms. A treadmill or stress test, also known as an exercise ECG (electrocardiogram), records the heart's electrical impulses under exertion; these tests may report a blockage where none exists, particularly in young women. Older women may not be able to reach the exercise intensity necessary on the treadmill to record any restricted blood flow.
All testing should be individualized and the best approach may be a combination of tests to evaluate symptoms. For example, in a thallium or sestamibi scan, radioactive substances that can assess blood flow may be used with the treadmill test to improve accuracy. An echocardiogram, which can assess the heart's pumping function, can also provide a complete profile. Drug alternatives that mimic the stress of exercise may be given to women who can't perform physically.
An examination for heart disease may include the following tests:
An ECG (or EKG) is a graphic record of the electrical activity of the heart as it contracts and rests. To record the ECG, a technician positions a number of small contacts on your arms, legs and chest to connect them to an ECG machine. An ECG can detect arrhythmias and heart damage, inadequate blood flow and heart enlargement.
For many women with angina, the ECG at rest is normal. This is not surprising because the symptoms of angina occur during stress. Therefore, the functioning of the heart may be tested under stress, typically exercise. In the simplest stress test, the ECG is taken before, during and after exercise to look for stress-related abnormalities. Blood pressure is also measured during the stress test and symptoms are noted.
An echocardiogram uses ultrasound to evaluate the shape, structure and strength of the heart muscle. This test is noninvasive and can be performed during rest or exertion.
Nuclear scanning is sometimes used to show damaged areas of the heart and expose problems with the heart's pumping action. A small amount of a radioactive substance is injected into a vein, usually in the arm. A scanning camera records the nuclear material that is taken up by the heart muscle (healthy areas) or not taken up (damaged areas). An initial test is recorded while resting; a second test while you perform near maximum intensity on the treadmill. After exercise, a scan is taken of the heart muscle, showing areas of decreased blood supply.
Coronary angiography is a test used to outline the coronary arteries. A fluid that appears on x-rays (a "contrast medium" or "dye") is injected through a fine tube (catheter) put into an artery of an arm or leg and passed into the heart. The heart and blood vessels are then filmed while the heart pumps. The picture that results, called an angiogram or arteriogram, shows problems such as a blockage caused by atherosclerosis. This is the most accurate way to assess the presence and severity of coronary disease.
High sensitivity C-reactive protein (CRP) blood test. This blood test detects a protein that becomes elevated in response to inflammation, called high sensitivity (hs) C-reactive protein (CRP). Inflammation caused by bacterial infection has long been implicated as a probable cause of atherosclerosis. The American Heart Association and the U.S. Centers for Disease Control and Prevention issued guidelines for the blood test in January 2003. The guidelines recommend limiting the use of the hs-CRP test as a discretionary tool for evaluating people of moderate risk, and not as a means of screening the entire adult population, as there is insufficient scientific evidence supporting widespread use at this time.
For more information on hs-CRP, visit the American Heart Association's Web site: www.americanheart.org.
Diagnosing a Heart Attack
Heart attack symptoms may not be sudden or dramatic like in the movies, so don't wait until symptoms are severe or unbearable. The warning signs of a heart attack are:
Discomfort that spreads from the chest to the shoulders, neck and arms
Pressure or squeezing pain in the chest that may spread into the neck, shoulders and arms
Nausea, breathlessness, sweating or fainting with pain in the arms, chest or neck
Feelings of impending doom
Significant fatigue
Problems sleeping
Indigestion
Weakness in the arms
If you have heart disease, you should know the symptoms of a heart attack so you can get immediate medical help if symptoms occur. Not all heart attacks begin with sudden, crushing chest pain, especially for women, for whom heart attack symptoms often are milder and less specific.
If a heart attack is suspected, doctors will order a blood test and an electrocardiogram (ECG) to test for changes in certain enzymes in the bloodstream and any disruption to the heart's electrical impulses. One such blood test, detects changed levels of troponin, a protein produced by the heart when it is damaged. Health care professionals may also check levels of enzymes called creatine kinase to determine if you have had a heart attack or if other muscles in your body have been damaged. Creatine kinase almost always rises in people who have had a heart attack, but levels of the enzyme can also be elevated for other reasons. Your health care professional will also most likely perform other tests to exclude other medical conditions.
